1. Introduction

2. Inject Local Anesthetic

3. Incision

4. Excision of Cyst

5. Closure

6. Post-op Remarks

Sebaceous cysts are closed sacs filled with foul-smelling, cheese-like material found underneath the skin. They form when a gland or hair follicle becomes blocked and are commonly found on the scalp, face, neck, or torso. Sebaceous cysts are non-cancerous and usually present as painless lumps, but can become tender when infected. In most cases, smaller sebaceous cysts may be ignored as they do not cause any symptoms; however, larger cysts may need to be removed with complete excision recommended to prevent recurrence. Oral antibiotics may be required when a sebaceous cyst becomes infected. Here, we present a 33-year-old male patient who underwent complete resection of a 2-year-old cyst.

<h4>CHAPTER 1</h4>

<p>So this is a cyst in the face. Initially when I was feeling it, it felt like a fat cyst, lipoma, but after… it seems like there's an area there, central area, the pore, it could be a cyst. So I'm just, for the face, it's a little more vascular, so I'm going to dilute some epinephrine to my local anesthesia, just to lessen the bleeding later on. For orientation, his chin is here, his eyes are here. So if you're looking at the cheek, normally a good incision to lessen the scarring would be a curvilinear incision. Something like this, towards the chin. There's the right eye.</p>

<h4>CHAPTER 2</h4>

<p>Injection now. So have the bevel up, you can see the needle. Bevel's up. One injection. It's spreading slowly through the skin. You can see it turning white. So that's the, that's a good block. Move a little back here. Here you can see it blanching again. Then you know that you're in the dermal layer. So normally, we wait for the epinephrine to take its effect, normally around 5 to 6 minutes. So then once we start the incision, it'll lessen the bleeding. So normally, face lesions are very vascular. So again, we- we just go around it. And I injected a little bit underneath. We're going to do a little under. Okay. It feels like a cyst. I think I got some infiltration inside the cyst. So you can see there's a punctum or the... Or you can see some anesthesia coming out. So we'll wait for 5 to 6 minutes, better - if you can wait 7\Nminutes, then better, but it will allow the epinephrine to take its effect on the capillaries in this area, which causes normally vasoconstriction. So, with vasoconstriction, when we make the incision, you won't have that much bleeding.</p>

<h4>CHAPTER 3</h4>

<p>We start the incision as mentioned, a little curvilinear. There's the cyst wall. Here, you could see it, the cyst. Try to make a smaller incision, I try to avoid hitting it. I think I hit part of it there, you see it coming out. Very thin wall.</p>

<h4>CHAPTER 4</h4>

<p>Again, it's important to get all the cyst wall to avoid its recurrence. Mosquito. Actually, it's on top, you can see this is, the cyst wall, here, differentiating it from a little shinier, which is the actual sebum already. So I think in this area, we- we opened it up. So I just stay- and not to be underneath. See the cyst coming out there? The cyst is almost out. There's some sebum coming out there. So here, I think this is still a good, still have a good cyst wall. Here, you can see the most inferior part. Here you could see, if you could do also this. Can I get a Mosquito? Just go right underneath the mass, and then just spread slowly. you can just see it popping out. There. Here I grab onto the lower tissue. And you're spreading it out slowly. Here you can see an opening here. There we go. I still got the cyst wall here, you can see the cyst wall is off. Here you go. So you should blunt dissection here to remove the whole cyst, completely. You have just a couple of more tissues still stuck, I just- use my blade to cut it off. Mosquito off. I cut everything off. So this is what I'm telling you about the cyst wall. This is bright and shiny.  Actual sebum coming out. Remove the whole mass, and it's not bleeding as much because of a combination of lidocaine and epinephrine.</p>

<h4>CHAPTER 5</h4>

<p>So I just make a small incision underneath. Undermine it, and make it easier to close it cosmetically better, just a small 5-0, closing the tissues and muscle. I use an inverted T. I get a small bite of tissue underneath. I make another small suture here in the side.</p>

<h4>CHAPTER 6</h4>

<p>When you cut the skin, probably don't go too deep, have a lighter incision. As you could see, I already nicked a bit of the capsule, but I followed it back down. So sometimes if you do get the capsule open, don't be worried. You could still find a normal capsule orientation to the normal tissues for a better plane on another area. Even if you've popped it already open. So it's, again it's important for us to remove the whole capsule to avoid recurrence of the cyst. So at that one, I think I probably, and most surgeons, sometimes nick the capsule, maybe once you incise the- the skin, you could already use blunt dissection by using a Mosquito. I- as I mentioned, I prefer using the blade. it's quicker, but maybe safer would be blunt dissection after you- you've incised the skin. I think those are normal mistakes that, we surgeons do when we have sebaceous or epidermal inclusion cyst surgeries. So, once that happens, I think it just takes technique, takes experience, I try to go in a little lighter until you find normal anatomy and a good plane. So management, of course you use- use of sutures for this type of face lesions would be fine sutures to avoid the markings after, when you remove the suture. So a 6-0, 5-0, 6-0 will be good for a repair or outside stitch. Same management will be postoperatively by giving antibiotics for infection and pain reliever for discomfort and pain.</p>

<p>33-year-old, we removed the cyst from his face. We put a plastic dressing. So a cyst from his face. I'm showing him his cyst, which he said has been with him for almost 2 years. I asked him why he hasn't gone to a surgeon, so, for this island, he said that there is no surgeon. For them to have the surgery then, they go and do it… which they- they spent those to 500 pesos from here to… and another 500 coming back. So it's 1000 pesos. So he's a tricycle driver, and, and spending that much just to have his cyst removed would cost a lot of- financial costs for them and the family. So… So he's very thankful for, for us coming here and doing the surgery so that he could save up money and, and use the money that he earns as a tricycle driver for his family. So he has 2 kids, 2 children and a wife, so that money could go a long way for them, for weeks here in, in the island of Sibuyan.</p>

Watch this full-length, narrated procedure of a sebaceous cyst excision during a surgical mission to the Philippines with the World Surgical Foundation.

DOI
Publication Date	2023/06/28
Article ID	268.19
Production ID	0268.19
Volume	2023
Issue	268.19
https://doi.org/10.24296/jomi/268.19

Sebaceous Cyst Excision

Procedure Outline

Table of Contents